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I do both. If I am creating something that has elements that crosses the page I will do it together as a 12x24. Then if I want to print it I just save each 12x12 side individually. You just have to watch out for the middle because you can lose some of it in printing. I usually don't put anything I'm not willing to lose in the last 1/4 inch, or if you have the grid on, in the last square along the middle.

I also do pages individually if the pages are more blocked because it's easier for me to see the elements. I don't have a big monitor so I really have to zoom in sometimes and I can't get the over all picture with the zoom all the way in.

You can get some templates that are 24 x 12
Or you can put two pages side by side to get the feel of what it will be as a two pager, by creating a new document that is 24 x12, and then drag and drop each side of the page on opposite sides of the new document.
Sometimes I do this just to get the web sized image to upload.
I dont usually save two pagers this way, since I would need to print them individually anyway.

I like Liz's suggestion of doing the two layouts separately, then dragging them onto the double-size canvas for the preview. But, like Erica says, if you've got an element that overlaps, you need to create the LO double-wide. Question: do any of the scrapbook printing sites or other sites (Costco, etc.) print the 24x12 size?

I always do my 2 pagers as side by side pages (two pages). The grid helps to line everything up b/c you can use it to "see" were things that stretch across the two pages should be to line up right. I ususally post them as two separate pages as well. It's just easier for me.